The myth about cholesterol

For years I’ve believed all the hype that high cholesterol sharply increases your risk for heart disease. I’m dubious about that now. Did you know that people with low cholesterol get heart attacks, too? Are you aware that nearly half of those with atherosclerosis have low cholesterol? Or that half of those with high LDL never suffer any complications? Something else seems to be going on.

I’ve suspected this for some time, but I didn’t know the mechanism behind it until now. Not all LDL is the same. A variant type exists, often hereditary, where the LDL type is smaller and denser, increasing your risk for heart attack or stroke. It isn't LDL per se, but the kind of LDL you have. This kind puts you at greater risk, since small LDL particles can more easily infiltrate the arteries and cause blockage. You can get a good reading at your doc’s on your cholesterol levels, LDL and HDL, be thin as a rail, exercise daily, yet still be at risk. You can even pass an EKG stress test and drop dead several days later. You come across this story often.

There are two things you should do, whether you agree or not with my particles hypothesis.

1. The next time you go for a blood check, which should be annually at the very least, ask for a particles check to determine the type of LDL you have. An added dividend is it will show whether you’re insulin resistant, a precursor to diabetes. Your test will even categorize your risk for heart attack or stroke: minimal, moderate, high, highest.

2. If you do have small particles, there are ways to improve, or transition, to large particles, the healthier kind; namely, cutting carbohydrates, especially from unrefined sources such as processed foods and sweets and exercising vigorously at least 150 minutes weekly, i.e., 30-minutes daily.

Be warned that eating fats, especially the saturated kind, has its own dangers, but in the end, unrefined carbohydrates are the primary threat to a healthy heart. If you think about it, carbohydrates are turned into blood sugar (glucose). If there's one insidious source of disease, not just coronary, it's sugar!

Let me close with my own experience. Last May I was found to have high small particle lipids. Over the last three months, I’ve practiced my own counsel. Result, my August lab showed a 25% drop in small particle total.

As always, sound nutrition is your key to good health and longevity.

rj

The patient succumbed to complications....

In following a news story about someone's demise, we often come across something like, "He succumbed to complications following routine surgery." The truth is that anyone undergoing surgery of any kind faces at the very least a one percent risk of never making it home again.

One percent might not seem much of a risk, but then we tend to think such things happen to the other guy, not us. Unfortunately, life is replete with the improbable and unanticipated every morning we get out of bed, and death has its way of cornering us in unexpected places.

I still remember a chance conversation I had many years ago with a custodian at Harvard who told me of the loss of her child during tonsillectomy. As I was very young, I don't think I took in its resonance as to the freakish nature of life itself, contributing not only to its mystery, but underscoring its frequent tragedy. I think it was Thomas Wolfe who wrote that a young man at 25 thinks himself immortal. (Say that to Keats, who knew better.) In my case, I was just 22.

A little more than a year ago, model and actress Mia Amber Davis died following knee surgery. She was 36. Dying from knee surgery? Yup, it happens.

There was also the unanticipated death of author Olivia Goldsmith, 54, whose Wives' Club became a popular movie. Following plastic surgery, she went into cardiac arrest, possibly induced by anesthesia. For me, the latter has always been the spookiest element in any surgery I've undergone. To borrow a phrase from poet William Carlos Williams, "so much depends on" an anesthesiologist.

Then there was the widely reported death of prominent Congressman John Murtha, 77, during "minimally invasive surgery" to remove his gall bladder. A close source told CNN that doctors accidentally "hit his intestines."

While natural causes such as a weak heart or allergic reaction to medication may often be factors in surgical mortality, the human capacity for error through misjudgment or negligence always looms, increasing the risk. Even good doctors make mistakes. The quandary is the more you do something well, the more the law of averages kicks in. Let's hope your surgeon is having a good day.

The bottom line is that our bodies treat any surgery as invasive, and human error compounds the danger. Surgery may be necessary, but it's never really "routine." Consider the case of Jenny Olenick, 17, who died of hypoxia (deficient oxygen to the brain) while undergoing anesthesia to have her wisdom teeth removed. While very rare, it's not unknown.

Of course, you can help lessen your risk by choosing your doctors well or considering a non-surgical alternative.

Unfortunately, we seldom get the choice as to the anesthesiologist. They just happen to be there, often rushing in from a previous procedure, and know precious little about us.

Next to death, surgery may be the ultimate in loss of control.

rj

I hadn't realized until recently....

I hadn't realized until recently just how much politics has intruded into medical  funding. And I'm not writing about the controversial "Obamacare," recently validated by the Supreme Court and set to go into full implementation in 2014.  This intrusion has its genesis through several administrations, going all the way back to the early 80s. Consider that current government bio-medical allocations by the National Institutes of Health include the following 2012 funding:

Heart disease: 2.2 billion (Deaths annually: 771,100; expenditure per patient: $27).

Diabetes: 1 billion (Deaths annually: 70,611; expenditure per person: $42).

Breast cancer: 778 million (Deaths annually: 41,049; expenditure per patient: $3,721).

Prostate cancer:  337 million  (Deaths annually: 28,517;  expenditure per patient: $177).

Obviously, men are being short-changed. But that's not the worst of it. Both sexes suffer dismal funding when you take HIV/AIDS funding into account:

.

HIV/AIDS: 3.2 billion (Deaths annually: 10,295; expenditure per patient: $3,047).

I find this shocking. But there is more to this egregious funding for a disease that pales when it comes to the mortality rates for our primary illnesses.

In addition to research allocations for HIV/AIDS, 15.6 billion has been designated for housing and cash assistance to HIV/AIDS patients. All of this pales when you consider our government, beginning with the recent Bush administration, has pledged itself to spending 50 billion on global AIDS.

Since1981, we've spent 170 billion on AIDS and continue to spend 20 billion annually on it, not including 24 billion in last year's budget.

Currently, there are about 81 million Americans with heart disease, according to the AHA.

The CDC's National Vital Statistics Report says that there are 24 million of us with diabetes, not including a larger number who are pre-diabetic.

Presently, some 1,200,000 of us have cancer.

It should be obvious that our health budget is out-of-wack when it comes to AIDs and blatantly unfair to the vast majority of us threatened with diseases vastly more dangerous.  

How did it get this way? When AIDS first became prominent in the early 80s it was, indeed, a hideous disease growing exponentially. Since then, mortality rates have declined nearly 18% and new medications have made HIV manageable.

At present, government health allocations are skewered and blatantly unfair, as well as injurious to the vast majority of us.  

Can anything be done? Unlikely, for it would be deemed PC, or anti-gay.  

One way out might be doubling the allocations for the 16 diseases with higher incident rates of occurrence and mortality than AIDS such as hepatitis and Alzheimer's. Not likely in a nation still reeling from a stagnant economy and its future enormously compromised with an ever increasing national debt.

Resources: 


Fair Foundation


Centers for Disease Control

i was reading somewhere....

I was reading somewhere that half of those who die from heart disease have low  cholesterol LDL, which of course flies in the face of long-standing medical emphasis on reducing the bad stuff.  But there's a new blood test in town that explains why you can have acceptable LDL, but still be in danger of a heart attack or stroke.  This test, performed by just two labs in the U.S., measures lipid particles for their size and density   Everyone should take this test on an annual basis at the very least. 

Unfortunately, the practice of relying on cholesterol scores can lead to fatal consequences, since it doesn't get at the causes of heart disease--poor nutrition, lack of exercise, and daily stress.  Statins don't even remotely touch on any of these factors, though It may be good for the pharmaceutical industry, contributing substantially to our bloated health costs.

In my last post, I mentioned the crucial role diet plays in preserving good health:  whole grains, fiber, and vegetables versus fats, sugar, refined flour, and lack of sufficient fiber.  As much as you can, focus on a plant based diet.

Writing in the Huffington Post, physician David Hyman cautions that "instead of looking just at the cholesterol numbers, we need to look at the cholesterol particle size. The real question is: Do you have small or large HDL or LDL particles. Small, dense particles are more atherogenic (more likely to cause the plaque in the arteries that leads to heart attacks), than large buoyant, fluffy cholesterol particles. Small particles are associated with pre-diabetes (or metabolic syndrome) and diabetes and are caused by insulin resistance."

What got me started on this entry is that I recently took the new test and was shocked to find I'm excessively high in small LDL particles.  Further that I'm experiencing insulin resistance, which can be a precursor to diabetes.

For years, I've been taking annual blood tests for cholesterol, and thinking everything is well.  Now I think again of that 50% fatality among people displaying low LDL cholesterol, many of them slender types like myself.

I'm actually thankful for the surprise results, as things aren't helpless.  You can decrease small LDL particles by adopting the eating habits I mentioned earlier and doing five thirty-minute exercise sessions weekly.  You might also try niacin supplements, but under a physician's monitoring.  Niacin has proven to be as effective as statins for many. 

One caution I need to add:  choose nutritious foods that have a low glycemic index, or convert to blood sugar more slowly.  Look out for the carbohydrates like white potatoes!

Do well and be well.

rj

I was recently reading....

I was recently reading a favorite minimalist blog.  You know, the kind that stresses simplifying one's life, something I wrote about recently.  The blogger writes about her teaming up with another blogger to reduce her sugar intake, not a bad idea, considering the increasing occurrence of obesity and diabetes, even in children.

She mentions that she eats an apple a day as her primary sugar intake.  If I remember things right, your sugar intake shouldn't exceed 36 grams daily.  An apple, at 25 grams, almost gets you there.  A medium banana nets you 14 grams.

This leads to a conundrum for me, to say the least.   After all, most medical sources recommend five daily servings of fruit, which help assure proper fiber intake and promote digestive health.  Assuming fruit is loaded with sugar, five helpings would suggest you'd be way over the max.

Out of curiosity, I checked the National Diabetes Association site and found they include fruit as a sugar source.  While they encourage you to eat fruit, you have to trade off with your carb intake.  Rather cumbersome, I'd say.  By the way, I wasn't aware before of how carbohydrates contribute to your blood glucose.  Cutting out sugar isn't as easy as it might appear.  Seems you almost need to be a chemist.  Just looking at the sugar content on a label doesn't suffice. 

On the other hand, there are the well-respected holistic doctors such as Neil Barnard and Joel Fuhrman, who shun limits on intake of fresh fruits, though not fruit drinks.  For them, the key is avoiding processed, or refined, foods.  This includes refined carbohydrates.  What about unrefined carbs such as brown rice?  These are the good guys, the complex carbs, which haven't had their fiber stripped away.

Who's right? I side with Fuhrman and Barnard.  Don't stress about carbs or fruit, unless you're diabetic.  Focus on fruits, plant foods, and the good carbs like oatmeal, rye, multigrain and sourdough breads, brown rice, pasta, etc.

You can also select more wisely by using a glycemic index chart, available online.  The GI indicates how quickly the food item converts to blood sugar.  White potatoes, for example, have a high GI.  Try a sweet potato instead.  Back to the complex carbs.  In general, they have lower GIs.

I've found medicine isn't an exact science.  Abounding in contradiction and uninformed, even dangerous, practices, you always have to be wary.  When it comes to sugar, say no to its common sources-- table sugar, cakes, pastries, sodas, etc.  But then don't forget the carbs and fruit.  Check their GI.  Avocados, for example, have a very low GI.

We are what we eat.  Better:  We become what we eat.  Did you know that 60 percent of our diseases come from what we eat?

Anybody for an apple?

Brain-tickling: n- back tasking

I’ve just returned from North Carolina, visiting my wife’s father in a nursing home. He turns 92 this Christmas. Right now, he’s recovering from a series of falls, the last one resulting in a broken ankle and hence nursing facility. Daddy is lucky in some respects, for the facility strikes me as well run, with sensitive staff (blessed with a sense of humor), decent meals even if institutional, and clean premises.

Yet in all of this, I couldn’t help taking in the white-haired residents, all of them in wheelchairs. Some seemed fixed, no movement throughout the day, heads bent, silent. One dear lady, presumably a stroke victim, courageous, tried to greet strangers, but she might well have spoken another language. In place of words, cheerily pitched sounds, but murmurings for all of that. In nearly a day at the place, I saw few visitors. If “loneliness is and always has been the central and inevitable experience of every person,” as writer Thomas Wolfe held, then its apex must be old age.

And yet there are things we can do to ease our journey into our senior years. For some time, I’ve been exercising daily, and rigorously, on our elliptical machine. Now I’ve added strength exercises three times a week, using weights to enhance muscle growth. After recently taking a bone scan test, I was delighted to learn I hadn’t lost any height, an occurrence as high as 80% in seniors.

I keep up with testing in general, whether annual blood checks or colonoscopies every three years, given my family’s cancer history. I get a flu shot every fall.

I haven’t touched meat in 15-years. I learned just the other day that only 15% of vegetarians suffer heart attacks. That’s good enough for me.

So much of preserving good health lies in adopting a preventative regimen, as Medicare and health insurers now increasingly recognize and encourage.

But there’s an aspect of maintaining good health that needs more attention. Consider that half of those past 85 suffer dementia. Now that’s huge! Think of the cost and the suffering, the diminishment in human dignity. We need to exercise our minds as well as our bodies.

I subscribe to Massachusetts General Hospital’s Mind, Mood & Memory. In its recent issue, the newsletter notes the success of those who exercise their brains, hence slowing down Alzheimer's, or even preventing it. Cross word puzzles, Sudoku games, learning a language, etc., all help--and a lot. This hits my palette, for I’ve generally favored games of mental skill like chess over games of chance.

New research indicates that the key to warding off dementia lies in boosting working memory. But how best to do this?

Turns out there’s a brain exercise called n-back that not only stimulates working memory (the kind used in reasoning and solving problems), but increases IQ. Hey, it actually makes you smarter!

Well, this got me going on my own research. I even bought the iPad application N-Back Suite. It’s as gorgeous as it’s friendly to users, allowing for stretching the mind through sensory stimuli (letters, images, sounds, colors, etc.).

With n-back tasking the idea is to remember items appearing in sequences. You can adjust your speed and there are ten levels of difficulty. Most of us will be lucky to get to level 3. It’s challenging.

It’s been tried with children and young adults, too. After 30 days of exercising for 20 minutes, results showed significant gains in fluid intelligence, i.e., the ability to recognize unfamiliar patterns and solve problems. IQ scores averaged 5 point gains. These results lasted 3 months, even though the participants were no longer doing the n-tasks. MGH neuropychologist Mimi Castelo calls the results “impressive.”

If all of this interests you, here are some web sites that offer sample n-back exercises. But don’t forget the iPad application I mentioned earlier.

http://dual-inback.com/nback.html

htpp://brainworkship.sourceforge.net

Good luck!

Combating the new global killers

The UN’s World Health Organization (WHO) has just announced that heart and lung disease, cancer, and diabetes are responsible for 63% of deaths globally. That surpasses the former number one killer, infectious diseases. WHO attributes the high mortality to largely preventable sources such as smoking, sedentary living, and faulty diet. In the West, Australia ranks first in heart and cancer mortality (35% heart; 20% cancer). 17 % of Australians smoke and a shocking 64% are obese. Unfortunately, Americans top the obesity scale, with some 71% of us overweight.  Global Burden Chart

One noticeable observation is that even third world countries are experiencing rising heart and cancer mortality, as their diets increasingly incorporate meat and daily products. Back in the 80s when noted Cornell nutritionist T. Colin Campbell made his blockbuster study of rural Chinese diets, heart disease and cancer were rare among those consuming an entirely plant based diet. The study’s empirical evidence has been confirmed in analyses differentiating Chinese immigrants and their offspring in the U. S. Americanized Chinese exhibit the same high incident rate for heart disease and cancer as the general population.

The real culprit here is animal protein, not fat per se. To avoid these chronic diseases the world needs to shift to a plant based diet. Studies give convincing evidence that doing so not only lessens the occurrence of heart disease, but often reverses it. Cancer incidence also decreases.

Ironically, our current health system contributes to our declining health with its continuing endorsement of a daily 30 gram fat content, low fat meat, fish, poultry, and dairy foods. Some doctors are downright defiant of plant diet research. Dr. Eduardo Azap, president of the Union For International Cancer Control, debunks the notion that “cancer is a problem of rich countries” as “a misconception" (Chronic Killers).  And yet when you look at WHO’s own listing, Ethiopia, for example, has a 4% cancer mortality rate; India, 6%. Contrast this with the U.S. 23% cancer mortality rate. It isn’t that we eat too much; it’s that we eat the wrong food.

Consider Harvard’s School of Public Health recently released alternative to the USDA’s MY Plate diet. Harvard’s plate seeks to offer more specific nutritional guidelines under the same USDA categories: fruits, vegetables, grains, and proteins. Nonetheless, the Harvard plate still recommends poultry and fish as good food sources, albeit, Harvard does make some helpful suggestions, for example, recommending whole grains in place of refined grains found in foods such as white bread and while rice, which contribute to heart disease and type 2 diabetes. It also makes a bold breakthrough in recommending water over milk.

Concurrently, an independent panel of 22 health experts (nutritionists, dieticians, cardiologists among them) reviewed 20 popular diets, with the Dash and Ornish diets finishing 1 and 3 respectively under Best Heart-Healthy Diets. Dr. Ornish advocates a virtual vegan diet that strongly resembles those proposed by Drs. Campbell, Mcdougall, Esselstyn and Fuhrman, stalwart pioneers with convincing empirical data behind their advocacy of a plant based diet in combating heart disease and cancer.

The truth about the Mediterranean diet

Diets come and go. Some are better than others. Some are downright dangerous. One such diet, still highly popular, and the basis for several others, is the Mediterranean diet, which draws upon French research (Lyon Diet Heart Study) centered in Cretan eating habits in the 1950s. Cretans were virtually free of heart attacks and obesity rare, despite more than 40% of their diet deriving from fat, or mostly olive oil. Otherwise, they consumed mostly fruits, veggies, beans and fish. They also worked very hard in the fields. Unfortunately, Americans got hung-up on the olive oil rather than the preponderancy of vegetables, concluding the oil was good for you.

French scientists experimented with the Cretan diet. Those on the Mediterranean diet suffered 50 to 70% fewer cardiac incidents. Now that’s pretty impressive, enough certainly to foster enthusiasm for the diet.

Today’s Mediterranean Diet, however, has little resemblance to the Cretan diet that formed the basis of the Lyon study. For many of us, it conjures up images of pasta and Italian bread, staples not friendly to your colon. There is more meat and poultry.

As for the experimental group in the study, four years after it began, 25% on the diet had died or experienced a cardiac event. As often happens, media coverage can be as shallow as it is volatile. So much for the success of the Mediterranean diet. The truth is that olive oil is one of the most calorically dense and fattening foods you can consume. On a pound for pounds basis, it’s worse than butter (3200 calories) vs olive oil (4,020). Moreover, 14 percent of olive oil is saturated fat. Since it can lead to weight increase, it can also increase LDL (the bad kind of cholesterol).

There is evidence that monounsaturated fat, found in olive oil, gives some protection from strokes. Nevertheless, because of its caloric density, only thin people should consume it, if at all. (See D. D. Blankenhorn, et al. ”The Influence of diet on the Appearance of New Lesions in Human Coronary Arteries.” Journal of the American Medical Association, Mar. 23, 1990.)

The brilliant Cornell epidemiologist who wrote the landmark, China Study, while acknowledging that the Mediterranean diets were virtually the same, commented, “I would say the absence of oil in the rural Chinese diet is the reason for their superior success“ (qtd. In Caldwell Esselstyn Jr., Prevent and Reverse Heart Disease, p. 84).

The upshot in all of this? If you want to eat healthy, minimize disease, control weight, and foster longevity, then a a plant-based diet is your best bet.

Oh, about the Cretans, they now eat like most of us and, like most of us, now suffer similar rates of heart attack, stroke, diabetes, colon and breast cancer.